On Being Sane in Insane Places

The Rosenhan Experiment was performed in 1973. It was a test to determine if "sanity" can be objectively determined by observation. The results had a lasting impact on proper diagnosis of mental illness, however, the implications go much deeper. Is insanity something that we can determine by observation or comparison with others?

The test was conducted in two parts, one in which healthy "false patients" told medical personnel they had experienced hallucinations and were admitted to 12 different psych hospitals. Part two involved having select staff at a different set of hospitals pick which patients they thought were fake, but no patients were actually sent. The general hospital staff were not told these experiments were being conducted in either Part 1 or Part 2.

None of the fake patients had any history of mental illness, they all were given the same medical complaint - vague auditory hallucinations, with no other symptoms. These patients were then instructed to act "normally" saying they felt fine and no longer heard the hallucinations. The average stay was 19 days, with some staying as long as 52 days until the staff decided they were "well" enough for release. The dehumanizing and labeling process took over from actual treatment and observation, and these "fake" patients ended up staying much longer than expected. Most of these fake patients were released with the stigma of "Schitzophrenia in Remission", though nothing was ever observed and it was all simply based upon hearsay.

Part 2 was not any better - out of 193 actual patients, 41 were reported to be fakes, and another 42 were suspected to be fake.

"I told friends, I told my family, 'I can get out when I can get out. That's all. I'll be there for a couple of days and I'll get out.' Nobody knew I'd be there for two months … The only way out was to point out that they're [the psychiatrists] correct. They had said I was insane, 'I am insane; but I am getting better.' That was an affirmation of their view of me." — David Rosenhan

A famous quote from the study concludes "It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals"